1
|
Shin DW, Kim JH, Song SW, Kim YH, Cho YH, Hong SH, Nam SJ. Posterior Fossa Teratomas in Adults : A Systematic Review. J Korean Neurosurg Soc 2021; 64:975-982. [PMID: 34521185 PMCID: PMC8590908 DOI: 10.3340/jkns.2020.0343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/09/2021] [Indexed: 11/27/2022] Open
Abstract
Objective The occurrence of posterior fossa teratomas in adulthood is extremely rare. In this study, we aimed to report our experience with two cases of posterior fossa mature teratoma in adults who underwent surgical resection. We also performed a systematic review of published papers available to date.
Methods We retrospectively reviewed the electronic medical records of patients who had onset of posterior fossa teratomas in adulthood at our institute between 1995 and 2020. We evaluated the clinical, radiographic, and pathological features of mature teratomas at the posterior fossa in adulthood. Furthermore, we searched the PubMed, EMBASE, and Web of Science database and reviewed published articles.
Results We found 507 articles on database review; of them, 102 were duplicates and 389 were excluded based on the inclusion criteria. Finally, 16 cases of posterior fossa from the web search and related articles. Subsequently, we added two cases that underwent surgery at our institute. We analyzed a total of 18 cases of mature teratomas. Headache was the most common (55.6%) symptom. The teratomas showed heterogeneous signals on magnetic resonance imaging. Thirteen patients (72.2%) had lesion at midline, five patients (27.8%) had calcification. Surgical resection was performed in all patients. No studies reported recurrence after resection.
Conclusion The occurrence of posterior fossa teratomas in adulthood is difficult to diagnose at the initial stage. Radiographic diagnosis alone can lead to misdiagnosis. Pathological confirmation is essential. Surgical resection is a curative option for posterior fossa teratomas in adulthood.
Collapse
Affiliation(s)
- Dong-Won Shin
- Department of Neurosurgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Jeong Hoon Kim
- Department of Neurosurgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Sang Woo Song
- Department of Neurosurgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Young-Hoon Kim
- Department of Neurosurgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Young Hyun Cho
- Department of Neurosurgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Seok Ho Hong
- Department of Neurosurgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Soo Jeong Nam
- Department of Pathology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| |
Collapse
|
2
|
Patil H, Garg N. Midline Posterior Fossa Mature Teratoma in a Child. J Pediatr Neurosci 2018; 13:252-254. [PMID: 30090150 PMCID: PMC6057187 DOI: 10.4103/jpn.jpn_5_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Teratomas are germ cell tumors commonly composed of cell types derived from all of the three germ layers. Intracerebral teratomas typically present in midline or paraxial lesions located in the pituitary stalk or the pineal region. Teratoma in posterior fossa is a rare entity. We reported a case of midline posterior fossa mature teratoma in a 3-month-old child.
Collapse
Affiliation(s)
- Harshad Patil
- Department of Neurosurgery, Bansal Hospital, Bhopal, Madhya Pradesh, India
| | - Nitin Garg
- Department of Neurosurgery, Bansal Hospital, Bhopal, Madhya Pradesh, India
| |
Collapse
|
3
|
Teratomas of the cranial vault: a systematic analysis of clinical outcomes stratified by histopathological subtypes. Acta Neurochir (Wien) 2017; 159:423-433. [PMID: 28091817 DOI: 10.1007/s00701-016-3064-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 12/21/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Teratomas of the cranial vault are divided into histopathological subtypes and grouped by prognoses: mature (good prognosis), mixed/malignant and immature teratomas (intermediate prognosis). This schema also includes non-teratomatous tumors. The authors of this study sought to elucidate histologically dependent predictors of survival and further clarify the classification system of intracranial teratomas. METHODS We performed a systematic analysis of the published literature to identify studies describing patients with intracranial teratomas diagnosed with magnetic resonance imaging (MRI) and presenting definite information on histologies, therapies, and outcomes at a minimum follow-up of 2 years. Disease-free (DFS) and overall survival (OS) were evaluated. RESULTS A total of 18 articles comprised of 134 patients were included. On univariate analysis, male sex and gross-total resection (GTR) were associated with high mean DFS (p = 0.0362 and p < 0.0001, respectively). On multivariate analysis, mature teratomas located in the pineal, and those having undergone subtotal resection (STR) demonstrated high mean OS (p = 0.0023 and p = 0.0044, respectively). Mature and mixed/malignant suprasellar teratomas had equally higher mean OS versus immature suprasellar teratomas (p < 0.0001). Mature and immature teratomas treated with adjuvant therapy had significantly higher mean OS compared to those managed with surgery alone (p = 0.0421 and p = 0.0423, respectively). Males with immature teratomas had the highest mean OS (p < 0.0001). Immature teratomas managed with surgery alone had higher mean DFS, but lower mean OS, compared to those treated with adjuvant therapy (p = 0.0176 and p = 0.0423, respectively). CONCLUSIONS Our data highlight the divergent nature of the different histopathological subtypes of teratomas, and suggest that survival outcomes are multifactorial. Specifically, male sex, pineal, suprasellar, GTR, and STR were dependent predictors of OS, while histopathology was an independent predictor of OS.
Collapse
|
4
|
Adorno A, Alafaci C, Sanfilippo F, Cafarella D, Scordino M, Granata F, Grasso G, Salpietro FM. Malignant teratoma in Klippel-Feil syndrome: a case report and review of the literature. J Med Case Rep 2015; 9:229. [PMID: 26438353 PMCID: PMC4595139 DOI: 10.1186/s13256-015-0700-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 08/31/2015] [Indexed: 11/17/2022] Open
Abstract
Introduction Klippel–Feil syndrome is characterized by a congenital fusion of cervical vertebrae. Intracranial teratomas are nongerminomatous germ cell tumors and they account for 0.3 to 0.9% of all intracranial tumors. Teratomas with malignant transformation refer to lesions which give rise to malignant cancer of somatic type. The association between tumors of dermoid origin and Klippel–Feil malformation is extremely rare. Only 23 other cases have so far been reported, and only one case of dermoid tumor with areas of dedifferentiation on squamous cell carcinoma has been described. Case presentation We report the case of a 72-year-old white man with a 2-year history of gait and balance disturbances. A brain magnetic resonance imaging revealed a fourth ventricle neoplastic process with infiltrative features. He was operated through a suboccipital craniectomy with a C1 laminotomy and bilateral vertebral artery transposition. At 6-months follow-up, magnetic resonance imaging showed an early regrowth of the fourth ventricle tumor, with the same radiological features. Conclusions Patients with Klippel–Feil malformation could develop posterior fossa dermoid tumors. The malignant potential of such tumors must be considered and surgery is recommended. Particular attention must be focused on the histopathological analysis in order to identify possible foci of malignant transformation.
Collapse
Affiliation(s)
- A Adorno
- Department of Neurosurgery - AOOR Papardo-Piemonte, Contrada Papardo, 98158, Messina, Italy.
| | - C Alafaci
- Department of Neurosurgery - AOU Policlinico "G.Martino", Via Consolare Valeria, 98125, Messina, Italy.
| | - F Sanfilippo
- Department of Neurosurgery - AOOR Papardo-Piemonte, Contrada Papardo, 98158, Messina, Italy.
| | - D Cafarella
- Department of Neurosurgery - AOOR Papardo-Piemonte, Contrada Papardo, 98158, Messina, Italy.
| | - M Scordino
- Department of Neurosurgery - AOOR Papardo-Piemonte, Contrada Papardo, 98158, Messina, Italy.
| | - F Granata
- Department of Neuroradiology, University of Messina, Messina, Italy.
| | - G Grasso
- Department of Neurosurgery - BIONEC, University of Palermo, Palermo, Italy.
| | - F M Salpietro
- Department of Neurosurgery - AOOR Papardo-Piemonte, Contrada Papardo, 98158, Messina, Italy.
| |
Collapse
|
5
|
Li Q, You C, Zan X, Chen N, Zhou L, Xu J. Mature cystic teratoma (dermoid cyst) in the sylvian fissure: a case report and review of the literature. J Child Neurol 2012; 27:211-7. [PMID: 22190504 DOI: 10.1177/0883073811415681] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Mature cystic teratoma (dermoid cyst) inside the Sylvian fissure is rare. A 14-year-old boy presented with 2 episodes of generalized tonic-clonic seizures. Using a fat-suppressed, T1-weighted sequence, magnetic resonance imaging revealed a hypointense nonenhancing mass in the left Sylvian fissure. He underwent left pterional craniotomy for total tumor resection. The pathological diagnosis was mature cystic teratoma (dermoid cyst). Headache and seizures are the leading symptoms. Cyst rupture causes inflammation of cholesterol crystals, and the cyst contents may cause seizure. Surgical resection is the treatment of choice, but radical resection is not advised if critical neurovascular structure can be injured.
Collapse
Affiliation(s)
- Qiang Li
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, PR China
| | | | | | | | | | | |
Collapse
|
6
|
Chiu CD, Chung WY, Pan DHC, Wong TT, Shih YH, Lee LS. Gamma knife radiosurgery for intracranial mature teratoma—long-term results and review of literature. ACTA ACUST UNITED AC 2006; 65:343-51. [PMID: 16531191 DOI: 10.1016/j.surneu.2005.07.075] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2005] [Accepted: 07/07/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND The purpose of this report is to present long-term outcomes of gamma knife radiosurgery for intracranial mature teratoma after debulking surgery. METHODS Three patients with intracranial mature teratoma had initial target volumes of 5.4, 18.7, and 5.1 cm(3), respectively, and were treated by gamma knife radiosurgery between 1993 and 2004. Marginal doses of 17, 12.5, and 13.5 Gy, respectively, were delivered to the tumors at isodose levels of 50%, 50%, and 62%, respectively. The first patient received radiosurgery after surgical removal and conventional radiotherapy. The second patient received similar management, including surgery and radiotherapy, with tumor recurrence. Two additional operations and subsequent radiosurgery were performed on this patient. Based on the favorable results of the first 2 patients, we performed radiosurgery instead of conventional radiotherapy after subtotal surgical removal in the last patient. By reviewing literatures concerning the therapeutic modalities and the long-term results of our 3 patients, we discuss the role of radiosurgery in treating intracranial mature teratoma. RESULTS A follow-up period of 121, 89, and 31 months, respectively, demonstrated tumor volume reduction rates of 70%, 89%, and 48%, respectively. No evidence of further tumor progression and no radiosurgery-related complication or morbidity was noted. The school performances of the affected children are all above average. CONCLUSIONS Gamma knife radiosurgery provides a safe and effective alternative as the adjuvant treatment of intracranial mature teratoma after surgical debulking. Previous conventional radiotherapy does not alter final tumor control. Radiosurgery should be considered when residual tumor growth continues with no related symptoms or evaluations of tumor markers during follow-up.
Collapse
Affiliation(s)
- Cheng-Di Chiu
- Department of Neurosurgery, Neurological Institute, Veterans General Hospital-Taipei, and National Yang-Ming University, Taipei, Taiwan 11217, Republic of China
| | | | | | | | | | | |
Collapse
|
7
|
Desai K, Nadkarni T, Muzumdar D, Goel A. Midline posterior fossa teratoma--case report. Neurol Med Chir (Tokyo) 2001; 41:94-6. [PMID: 11255635 DOI: 10.2176/nmc.41.94] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 20-day-old female neonate presented with an immature teratoma in the midline posterior fossa. The tumor was totally removed but the patient died of pneumonia. Teratoma is a rare tumor, but very difficult to treat as the patients tend to be young, and the outcome is very poor.
Collapse
Affiliation(s)
- K Desai
- Department of Neurosurgery, King Edward Memorial Hospital, Seth G. S. Medical College, Parel, Mumbai, India
| | | | | | | |
Collapse
|
8
|
Lalwani AK. Meningiomas, Epidermoids, And Other Nonacoustic Tumors Of The Cerebellopontine Angle. Otolaryngol Clin North Am 1992. [DOI: 10.1016/s0030-6665(20)30970-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
9
|
Abstract
Two neonates with intracranial teratomas presented with cranial enlargements a few weeks after birth. Both cases underwent surgery: one died intraoperatively; the other is the longest known survivor, alive 7 years and 9 months after subtotal excision of a mature teratoma of the left sylvian fissure. Previous operations have been relatively few and nearly all have been unsuccessful. Size and favorable location may be the most important prognostic features regardless of the histologic classification as mature or immature. One of our cases demonstrates that even subtotal excision of a mature teratoma can result in long-term survival.
Collapse
Affiliation(s)
- S J Hunt
- Division of Neuropathology, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | | | | | | |
Collapse
|
10
|
Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 20-1990. A 16-year-old boy with a lesion of the left frontal lobe. N Engl J Med 1990; 322:1446-58. [PMID: 2330014 DOI: 10.1056/nejm199005173222008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
11
|
Jennings MT, Gelman R, Hochberg F. Intracranial germ-cell tumors: natural history and pathogenesis. J Neurosurg 1985; 63:155-67. [PMID: 2991485 DOI: 10.3171/jns.1985.63.2.0155] [Citation(s) in RCA: 496] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The natural history of primary intracranial germ-cell tumors (GCT's) is defined from 389 previously published cases, of which 65% were germinomas, 18% teratomas, 5% embryonal carcinomas, 7% endodermal sinus tumors, and 5% choriocarcinomas. Intracranial GCT's display specificity in site of origin. Ninety-five percent arise along the midline from the suprasellar cistern (37%) to the pineal gland (48%), and an additional 6% involve both sites. The majority of germinomas (57%) arise in the suprasellar cistern, while most nongerminomatous GCT's (68%) preferentially involve the pineal gland (p less than 0.0001). The age distribution of afflicted patients is unimodal, centering with an abrupt surge in frequency in the early pubertal years; 68% of patients are diagnosed between 10 and 21 years of age. Nongerminomatous GCT's demonstrate an earlier age of onset than do germinomas (p less than 0.0001). Prolonged symptomatic intervals prior to diagnosis are common in germinomas (p = 0.0007), in suprasellar GCT's (p = 0.001), and among females (p = 0.02). Parasellar germinomas commonly present with diabetes insipidus, visual field defects, and hypothalamic-pituitary failure. Nongerminomatous GCT's present as posterior third ventricular masses with hydrocephalus and midbrain compression. Germ-cell tumors may infiltrate the hypothalamus (11%), or disseminate to involve the third ventricle (22%) and spinal cord (10%). Among a subpopulation of 263 conventionally treated patients, two factors were of prognostic significance: 1) histological diagnosis; germinomas were associated with significantly longer survival than nongerminomatous GCT's (p less than 0.0001); and 2) staging of the extent of disease; this emphasizes the ominous character of involvement of the hypothalamus (p = 0.0002), third ventricle (p = 0.02), or spinal cord (p = 0.01). Specific recommendations regarding the necessity of histological diagnosis and staging of the extent of disease are made in light of modern chemotherapeutic advances. The pathogenesis of GCT's may be revealed by their specificity of origin within the positive (suprasellar cistern-suprachiasmatic nucleus) and negative (pineal) regulatory centers for gonadotropin secretion within the diencephalon. The abrupt rise in age distribution at 10 to 12 years suggests that the neuroendocrine events of puberty are an "activating" influence in the malignant expression of these embryonal tumors.
Collapse
|
12
|
Nakamura Y, Sato T, Nishimura G, Tanimura A, Takahashi Y, Hachisuka H, Masaike K, Yanai T, Hashimoto H. Malignant teratoma in the brain. An immunohistochemical study. Cancer 1985; 55:103-7. [PMID: 3880652 DOI: 10.1002/1097-0142(19850101)55:1<103::aid-cncr2820550117>3.0.co;2-k] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A case of intracranial malignant teratoma found in a 27-year-old man was reported. This unique tumor was found in the right frontal lobe separated from the pineal region and revealed various tissue components such as stratified squamous epithelium, glandular tissues, neuron, glia, ependyma, fibromuscular tissue, cartilage, bone, hemangiomatous lesion, melanin-laden cells, and some germ cell components. An immunohistochemical study demonstrated the presence of S-100 protein, glial fibrillary acidic protein (GFAP), neuron-specific enolase (NSE), carcinoembryonic antigen (CEA), and Factor VIII in some tumourous components. In particular, the distribution of S-100 protein in some germ cells suggested the possibility of the neuroectodermal origin of the germ cells or, alternatively, differentiation to the neuroectoderm.
Collapse
|
13
|
Abstract
A case of double teratomas located in the pineal region and the fourth ventricle is presented. A simultaneous occurrence from nonmetastatic, separate origins seems rare in cases of mature teratomas. Computerized tomographic scans led to detection of another asymptomatic teratoma. Surgical treatment produced good results.
Collapse
|
14
|
Zimmerman RA, Bilaniuk LT, Dolinskas C. Cranial computed tomography of epidermoid and congenital fatty tumors of maldevelopmental origin. THE JOURNAL OF COMPUTED TOMOGRAPHY 1979; 3:40-50. [PMID: 263602 DOI: 10.1016/0149-936x(79)90059-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The computed tomographic and clinical findings in 17 patients with fatty intracranial tumors and in 10 patients with epidermoid tumors, all of maldevelopmental origin, are presented. Fat was found in lipomas (the most frequent), dermoids, and teratomas. Differentiation between these tumors is discussed on the basis of density, calcification, location, and symptomatology.
Collapse
|
15
|
Hübner G. Intracerebral metastatic malignant teratoma in the region of the optic chiasm. BEITRAGE ZUR PATHOLOGIE 1976; 157:189-99. [PMID: 1275862 DOI: 10.1016/s0005-8165(76)80104-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
An intracerebral metastatic teratoma in a 10-year-old girl is described. This is only the third case that has been reported in literature. Autopsy revealed a cystic tumour measuring 4 cm in diameter in the region of the optic chiasm. Microscopic examination showed that it contained all 3 germinal layers. It was classified in accordance with the criteria of Collins and Pugh as a malignant teratoma intermediate A (M.T.I.A.). Metastases had developed upstream and downstream of the CSF flow in the rostral segment of the pons, the medulla oblongata and the cerebellum as well as in the region of the posterior commissure above the lamina quadrigemina and the pineal body. In addition, there were also leptomeningeal metastases in the region of the left Sylvian furrow. The different opinions of various authors regarding the malignant potency of intracranial teratomas are raised and discussed.
Collapse
|